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Rogers MJ, Ou Z, Clawson JW, Presson AP, Stockburger CL, Kazmers NH. The Relationship Between Patient-Reported Outcomes and Patient Satisfaction With Ligament Reconstruction Tendon Interposition. J Hand Surg Am 2023; 48:1218-1228. [PMID: 37737802 PMCID: PMC10841050 DOI: 10.1016/j.jhsa.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Achieving the minimal clinically important difference (MCID) on an outcomes instrument and reporting satisfaction with surgical outcomes are not equivalent. We hypothesized that improvement exceeding the QuickDASH and PROMIS UE CAT MCID is associated with a greater likelihood of reporting satisfaction with ligament reconstruction tendon interposition (LRTI) treatment. Our secondary hypothesis was that a subset of patients failing to meet MCID would still be satisfied. METHODS Patients ≥1 year after LRTI at one academic tertiary institution were included. QuickDASH and UE CAT v1.2 scores were obtained before and after surgery. Postoperative satisfaction and levels of improvement in pain and function were also obtained. RESULTS A total of 93 patients completed the QuickDASH, and of those, 90 also completed the UE CAT. At a mean of 2.6 ± 1.0 years after surgery, QuickDASH and UE CAT score improvement exceeded the previously published MCID estimates of 8.8 and 4.8. Although 90% (84/93) of the patients reported satisfaction, only 85% (72/93) and 72% (59/90) achieved MCID on the QuickDASH and UE CAT, respectively. Using the MCID estimate of 8.8, 96% (72/75) of the patients meeting the MCID were satisfied with their treatment. Those failing to achieve MCID reported significantly less physical function and pain improvement; however, most were satisfied nonetheless (68% [13/19] for QuickDASH, 77% [23/30] for UE CAT). CONCLUSIONS Achieving published MCID thresholds on the QuickDASH and PROMIS UE CAT v1.2 was predictive of patients reporting general satisfaction with their LRTI outcome ≥1 year after surgery. Most patients failing to achieve MCID still reported satisfaction with their LRTI. Achieving MCID thresholds alone should not be used as a surrogate for patient satisfaction with their treatment. Patient satisfaction is a complicated construct that is potentially very different from that of high-quality care. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Miranda J Rogers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Jordan W Clawson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | | | - Nikolas H Kazmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
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Than CA, Adra M, Curtis TJ, Shi A, Kim GE, Nakanishi H, Matar RH, Brown JMM, Dannawi Z, Beck BR. The effect of exercise post vertebral augmentation in osteoporotic patients: A systematic review and meta-analysis. J Orthop Res 2023; 41:2703-2712. [PMID: 37203781 DOI: 10.1002/jor.25631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/26/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023]
Abstract
This meta-analysis investigated the effects of exercise on Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores following vertebroplasty or kyphoplasty in osteoporotic fractures. A literature search of PubMed, EMBASE (Elsevier), CiNAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from database inception to October 6, 2022. Eligible studies reported osteoporosis patients over 18 years of age with a diagnosis of at least one vertebral fracture via radiography or clinical assessment. This review was registered in PROSPERO (ID: CRD42022340791). Ten studies met the eligibility criteria (n = 889). VAS scores at baseline were 7.75 (95% CI: 7.54, 7.97, I2 = 76.11%). Following initiation of exercise, VAS scores at the endpoint of 12 months were 1.91 (95% CI: 1.53, 2.29, I2 = 92.69%). ODI scores at baseline were 68.66 (95% CI: 56.19, 81.13, I2 = 85%). Following initiation of exercise, ODI scores at the endpoint of 12 months were 21.20 (95% CI: 14.52, 27.87, I2 = 99.30). A two-arm analysis demonstrated improved VAS and ODI for the exercise group compared to non-exercise control at 6 months (MD = -0.70, 95% CI: -1.08, -0.32, I2 = 87% and MD = -6.48, 95% CI: -7.52, -5.44, I2 = 46%, respectively) and 12 months (MD = -0.88, 95% CI: -1.27, -0.49, I2 = 85% and MD = -9.62, 95% CI: -13.24, -5.99, I2 = 93%). Refracture was the only adverse event reported and occurred almost twice as frequently in the non-exercise group than in the exercise group. Exercise rehabilitation post vertebral augmentation is associated with improved pain and functionality, particularly after 6 months of exposure, and may reduce refracture rate.
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Affiliation(s)
- Christian A Than
- St George's University of London, London, UK
- University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Maamoun Adra
- St George's University of London, London, UK
- University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Tom J Curtis
- St George's University of London, London, UK
- University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Ao Shi
- St George's University of London, London, UK
- University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Grace E Kim
- St George's University of London, London, UK
- University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Hayato Nakanishi
- St George's University of London, London, UK
- University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Reem H Matar
- St George's University of London, London, UK
- University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - J Mark M Brown
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Zaher Dannawi
- Mid and South Essex NHS Foundation Trust, Basildon, UK
| | - Belinda R Beck
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
- The Bone Clinic Pty Ltd, Brisbane, Queensland, Australia
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Cui P, Wang S, Wang P, Yang L, Kong C, Lu S. Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol. Front Surg 2022; 9:997657. [DOI: 10.3389/fsurg.2022.997657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundEnhanced recovery after surgery (ERAS) is an evidence-based multimodal perioperative management designed to reduce the length of stay (LOS) and complications. The purpose of the present study is to evaluate the recovery of physiological function, LOS, complications, pain score, and clinical efficacy in frail elderly patients undergoing multisegment fusion surgery after the implementation of the ERAS protocol.MethodsFrail patients older than 75 years undergoing multilevel lumbar fusion surgery for degenerative discogenic conditions, lumbar spinal stenosis, and lumbar spondylolisthesis from January 2017 to December 2018 (non-ERAS frail group) and from January 2020 to December 2021 (ERAS frail group) were enrolled in the present study. Propensity score matching for age, sex, body mass index, and smoking status was performed to keep comparable characteristics between the two groups. Further recovery of physiological function, LOS, complications, pain score, and clinical efficacy were compared between the groups.ResultsThere were 64 pairs of well-balanced patients, and the clinical baseline data were comparable between the two groups. There was significant improvement in terms of recovery of physiological function (10.65 ± 3.51 days vs. 8.31 ± 3.98 days, p = 0.011) and LOS (12.18 ± 4.69 days vs. 10.44 ± 4.60 days, p = 0.035), while no statistical discrepancy was observed with regard to complications between the groups, which indicated favorable outcomes after the implementation of the ERAS protocol. Further analysis indicated that more patients were meeting a minimally clinical important difference for the visual analog score for the legs and the Oswestry Disability Index in the ERAS frail group. With regard to postoperative pain, the score was higher in the ERAS frail group than in the non-ERAS frail group on postoperative day (POD) 1 (4.88 ± 1.90 in the ERAS frail group vs. 4.27 ± 1.42 in the non-ERAS frail group, p = 0.042), while there was no significant discrepancy on POD 2 (3.77 ± 0.88 in the ERAS frail group vs. 3.64 ± 1.07 in the non-ERAS frail group, p = 0.470) and POD 3 (3.83 ± 1.89 in the ERAS frail group vs. 3.47 ± 1.75 in the non-ERAS frail group, p = 0.266).ConclusionsIn this retrospective cohort study, we found a significant improvement in terms of LOS, recovery of physiological function, and clinical efficacy after the implementation of the ERAS protocol in elderly and frail patients undergoing multilevel lumbar fusion surgery, while there was no significant discrepancy with regard to complications, 90-day readmission, and postoperative pain.
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Kim K, Kokubo R, Isu T, Morimoto D, Morita A. Patient satisfaction with cluneal nerve entrapment surgery. Acta Neurochir (Wien) 2022; 164:2667-2671. [PMID: 35972558 DOI: 10.1007/s00701-022-05344-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Low back pain (LBP) from superior or middle cluneal nerve entrapment has been addressed surgically. We recorded patient satisfaction with this treatment. METHODS We included 22 consecutive patients who had undergone surgery for unilateral cluneal nerve entrapment (superior: n = 17, middle: n = 5). The numerical rating scale (NRS) for LBP, the Oswestry Disability Index (ODI) score, and the EuroQOL 5-dimension, 5-level (EQ-5D-5L) scale before and 6 months after the operation were compared. Using these scores, the treatment outcome was compared with the patients' preoperative expectations. RESULTS LBP was ameliorated in all 22 patients; their NRS, ODI, and EQ-5D-5L were significantly improved after surgery. Surgical satisfaction based on the postoperative NRS scores was recorded as 8.8 ± 1.1 (range 7-10). While the postoperative was significantly better than the expected NRS, the postoperative ODI was significantly higher than expected by the patients (both: p < 0.05). There was a moderate correlation between the postoperative NRS and ODI and postoperative patient satisfaction. CONCLUSION Patient satisfaction with the surgical result was rated as acceptable.
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Affiliation(s)
- Kyongsong Kim
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Kamagari, Inzai City, Chiba, 1715, Japan.
| | - Rinko Kokubo
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Kamagari, Inzai City, Chiba, 1715, Japan
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan
| | - Daijiro Morimoto
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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